| Entity Name: | CHARLOTTE PAIN CLINIC, INCORPORATED |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 05 Sep 2007 (17 years ago) |
| Date of dissolution: | 30 Apr 2009 (16 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 30 Apr 2009 (16 years ago) |
| Document Number: | P07000099153 |
| FEI/EIN Number | 260861546 |
| Address: | 3109 TAMIAMI TRAIL, UNIT 3, PORT CHARLOTTE, FL, 33952 |
| Mail Address: | 3109 TAMIAMI TRAIL, UNIT 3, PORT CHARLOTTE, FL, 33952 |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932389764 | 2007-11-08 | 2007-11-14 | 3109 TAMIAMI TRL, UNIT 3, PORT CHARLOTTE, FL, 339528046, US | 3109 TAMIAMI TRL, UNIT 3, PORT CHARLOTTE, FL, 339528046, US | |||||||||||||||||||||||||
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| Phone | +1 941-629-3000 |
| Fax | 9416296711 |
Authorized person
| Name | NANCY J HARRIS |
| Role | OWNER |
| Phone | 9416293000 |
Taxonomy
| Taxonomy Code | 208VP0000X - Pain Medicine Physician |
| License Number | ME16509 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA LICENSE |
| Number | RN1855592 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HARRIS NANCY J | Agent | 32 TORRINGTON ST, PORT CHARLOTTE, FL, 33954 |
| Name | Role | Address |
|---|---|---|
| HARRIS NANCY | President | 32 TORRINGTON ST, PORT CHARLOTTE, FL, 33954 |
| Name | Role | Address |
|---|---|---|
| LITHE LEW A | Vice President | 3109 TAMIAMI TRL #3, PORT CHARLOTTE, FL, 33952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2009-04-30 | No data | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2009-04-30 |
| ANNUAL REPORT | 2008-06-30 |
| Domestic Profit | 2007-09-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
